Provider Demographics
NPI:1750616397
Name:INOVA RESTON MRI CENTER LLC
Entity type:Organization
Organization Name:INOVA RESTON MRI CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-289-2048
Mailing Address - Street 1:2722 MERRILEE DR
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4420
Mailing Address - Country:US
Mailing Address - Phone:703-788-8477
Mailing Address - Fax:703-698-2176
Practice Address - Street 1:100 ELDEN ST STE 16M
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4873
Practice Address - Country:US
Practice Address - Phone:703-481-9400
Practice Address - Fax:703-481-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3120417OtherUHC
VA9616343OtherAETNA - PPO
VA1972838993Medicaid
WV3810017668Medicaid
VA6123294OtherAETNA HMO
VA6123294OtherAETNA HMO
DC166599Medicare PIN